Products of conception: Difference between revisions
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{{Top | <noinclude>{{Top | ||
|author1=[[User:Mikael Häggström|Mikael Häggström]] | |author1=[[User:Mikael Häggström|Mikael Häggström]] | ||
|author2= | |author2= | ||
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{{Comprehensiveness}}</noinclude> | |||
{{Comprehensiveness}} | |||
==Gross processing== | ==Gross processing== | ||
Look up the gestational age of the pregnancy. | Look up the gestational age of the pregnancy. | ||
*Look for '''fetal tissue''' (fetus, fetal membranes or chorionic villi). If chorionic villi are found, no lengthy search is needed for other kinds of fetal tissue, just a quick look for obvious ones. Membranous material is less reliable, and may still indicate further sampling. Inspect any found fetal tissue for gross anomalies. If found, submit one piece of the fetus and one piece of the placenta.<ref name=Chicago>{{cite web|url=https://voices.uchicago.edu/grosspathology/peds-perinatal/products-of-conception/|title=Gross Pathology Manual, By The University of Chicago Department of Pathology - Products of Conception|accessdate=2020-08-13}}</ref> | *Look for '''fetal tissue''' (fetus, fetal membranes or chorionic villi). They are generally easier to distinguish from decidua (which is maternal tissue) when fragments are put in clear fluid and shaken, with chorionic villi having a consistency like orange pulp, whereas decidua is more rubbery. The fluid may be formalin if no sample for genetic workup is needed. If chorionic villi are found, no lengthy search is needed for other kinds of fetal tissue, just a quick look for obvious ones. Membranous material is less reliable, and may still indicate further sampling. Inspect any found fetal tissue for gross anomalies. If found, submit one piece of the fetus and one piece of the placenta.<ref name=Chicago>{{cite web|url=https://voices.uchicago.edu/grosspathology/peds-perinatal/products-of-conception/|title=Gross Pathology Manual, By The University of Chicago Department of Pathology - Products of Conception|accessdate=2020-08-13}}</ref> | ||
<gallery mode=packed heights=180> | <gallery mode=packed heights=180> | ||
File:Gross pathology of chorionic villi at 10 weeks.jpg|Fresh '''chorionic villi''' (arrows), surrounded by decidua, at 10 weeks of gestational age. | File:Gross pathology of chorionic villi at 10 weeks.jpg|Fresh '''chorionic villi''' (arrows), surrounded by decidua, at 10 weeks of gestational age. | ||
File:Gross pathology of chorionic villi.jpg|'''Chorionic villi''' (arrow) become more | File:Gross pathology of chorionic villi.jpg|'''Chorionic villi''' (arrow) become more characteristic when held in fluid, having a fibrillary shape | ||
File:Gross pathology of | File:Gross pathology of chorionic villi and decidua.jpg|Fresh chorionic villi (left) compared to decidua (right). | ||
File:Gross pathology of fixed chorionic villi.jpg|'''Chorionic villi''' become more pale when fixed in formalin. | File:Gross pathology of fixed chorionic villi.jpg|'''Chorionic villi''' become more pale when fixed in formalin. | ||
File:Macropathology of umbilical cord, amnion and chorionic villi at 7-13 weeks of gestational age.jpg|Macropathology of fixed umbilical cord, amnion and chorionic villi at 7-13 weeks of gestational age | File:Macropathology of umbilical cord, amnion and chorionic villi at 7-13 weeks of gestational age.jpg|Macropathology of fixed umbilical cord, amnion and chorionic villi at 7-13 weeks of gestational age | ||
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*If fetal parts are not visually found, search for diagnostic '''placental tissue''', which is soft and shaggy or spongy (as opposed to membranous, which is likely to be decidua or blood clots).<ref name=Chicago/> | *If fetal parts are not visually found, search for diagnostic '''placental tissue''', which is soft and shaggy or spongy (as opposed to membranous, which is likely to be decidua or blood clots).<ref name=Chicago/> | ||
*If '''no fetal or placental tissue''' is found, all presented tissue generally needs to be submitted. | *If '''no fetal or placental tissue''' is found, all presented tissue generally needs to be submitted. | ||
{{Moderate-begin}}If transported or processed together with other cases, put any chorionic villi in thin-mesh cassettes or tissue bags to limit contamination{{Moderate-end}}.<ref group=note>Chorionic villi are promiscuous contaminants of other tissues, and may cause a false positive finding for another cassette containing products of conception.<br>- {{cite journal| author=Carll T, Fuja C, Antic T, Lastra R, Pytel P| title=Tissue Contamination During Transportation of Formalin-Fixed, Paraffin-Embedded Blocks. | journal=Am J Clin Pathol | year= 2022 | volume= 158 | issue= 1 | pages= 96-104 | pmid=35195717 | doi=10.1093/ajcp/aqac014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35195717 }} </ref> | |||
===Gross report=== | ===Gross report=== | ||
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[[File:Histopathology of chorionic villi at gestational age of 9 weeks.jpg|130px|right]] | [[File:Histopathology of chorionic villi at gestational age of 9 weeks.jpg|130px|right]] | ||
{{Comprehensive-begin}}Products of conception | {{Comprehensive-begin}}Products of conception:{{Comprehensive-end}} Products of conception, including immature chorionic villi, corresponding to first trimester pregnancy. {{Comprehensive-begin}}Spontaneous abortion, clinically.{{Comprehensive-end}} | ||
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[[File:Histology of implantation site intermediate trophoblasts.jpg|130px|right]] | [[File:Histology of implantation site intermediate trophoblasts.jpg|130px|right]] | ||
{{Comprehensive-begin}}Products of conception | {{Comprehensive-begin}}Products of conception:{{Comprehensive-end}} Fragments of focally necrotic decidua and implantation site, consistent with intrauterine products of conception. Negative for chorionic villi. | ||
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{{Bottom}} | <noinclude>{{Bottom}}</noinclude> | ||